POS1465 COMPLICATED QUESTIONS YET SIMPLE ANSWERS. A CASE OF THIAMIN DEFICIENCY MISTAKEN FOR SJOGREN’S SYNDROME.
Authors: Y. Abbas, A. Mahdi, S. Hammadi
Journal: Annals of the Rheumatic Diseases (2022)

Background Sialosis is a non inflammatory nor neoplastic expansion of the salivary glands. it is a common mimicker for obstructive, inflammatory and malignant salivary gland disorders.(1) It had been described in acromegaly, vitamin A, and Thiamin deficiency and in amylophagia and bulimia.(2-5) Imaging should be normal in Sialosis(6) Here we describe a case of Sialosis due to Vitamin deficiency who was treated for a few months with anti-tuberculous and anti inflammatory drugs. Objectives To raise awareness about this cause of parotid swelling and encourage practice of exclusion prior to treatment. Methods A 30 year old lady with no significant past medical history presented to us with 2 years of slowly progressive, non tender bilateral facial swellings, with no excess or reduced salivation and no pain upon eating, she had negative history of preceding upper respiratory tract infection. the condition was associated with feeling a lump in her right axilla, and cervical region, there was no fever or systemic manifestations. she consulted a surgeon during that period, an exisional biopsy of the lump revealed the presence of fatty lumps, she was then prescribed antituberculosis medications since her symptoms were vague and because TB is quite common in Iraq. She denied any improvement with these medications. She then was prescribed treatment with hydroxyChloroquin and prednisolone by another physician assuming she had sjogren’s syndrome. When we saw the patient she was extremely distressed and depressed, had bilateral diffused parotid swellings, along with submandibular swelling, no mass could be felt during the exam, her mandibles and neck appeared large, she had normal tear film production and negative eye test, with no articular or muscular abnormalities. Results Her Labs were negative, and ultrasound for the parotids revealed enlarged glands with normal texture, MRI showed enlarged both parotids and submandibular glands with no other abnormality, minor salivary gland biopsy showed normal tissue with no inflammatory cell infiltrates. she had normal thyroid, parathyroid and growth hormone levels, normal metabolic panel and denied history of Alcohol consumption of Bulimia, but rarely consumed meat. a trial of Vitamin A, Thiamin and pilocarpine was started, the patient reported regression in the size of the swellings after 2 weeks of therapy but then developed mucosal dryness, afterwards, Vitamin A was stopped, she developed bone pain with normal bone markers and for that reason, pilocarpine was stopped. despite stopping these medicines, the size continued to regress on thiamin supplement alone, and she was prescribed anxiolytics and antidepressants by a Neurologist. Figure 1. Showing the appearance A, before and B after one month of treatment. Conclusion Sialosis can be a manifestation of variable metabolic and endocrine conditions and it should be kept in mind when facing a patient with parotid swelling being a potentially treatable cause. References [1]References in Sialosis: 35 cases of persistent parotid swelling from two countries - British Journal of Oral and Maxillofacial Surgery [Internet]. [cited 2022 Jan 20]. Available from: https://www.bjoms.com/article/S0266-4356 (08)00040-5/references [2]Salivary Swelling | Iowa Head and Neck Protocols [Internet]. [cited 2022 Jan 20]. Available from: https://medicine.uiowa.edu/iowaprotocols/salivary-swelling [3]Yu YH, Park YS, Kim SH, Son BK, Jun DW, Jo YJ, et al. Sialadenosis in a Patient with Alcoholic Fatty Liver Developing after Heavy Alcohol Drinking. Korean J Gastroenterol. 2009 Jul 31;54(1):50–4. [4]Scully C, Eveson J. Sialosis and necrotising sialometaplasia in bulimia; a case report. International Journal of Oral and Maxillofacial Surgery. 2004 Dec 1;33(8):808–10. [5]Scully C, Bagán JV, Eveson JW, Barnard N, Turner FM. Sialosis: 35 cases of persistent parotid swelling from two countries. British Journal of Oral and Maxillofacial Surgery. 2008 Sep;46(6):468–72. [6]Sialosis | Radiology Reference Article | Radiopaedia.org [Internet]. [cited 2022 Jan 20]. Available from: https://radiopaedia.org/articles/sialosis-1 Disclosure of Interests None declared